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The Poor Outcome of Ischemic Stroke in Very Old People: A Cohort Study of Its Determinants
Author(s) -
Denti Licia,
Scoditti Umberto,
Tonelli Claudio,
Saccavini Marsilio,
Caminiti Caterina,
Valcavi Rita,
Benatti Mario,
Ceda Gian Paolo
Publication year - 2010
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2009.02616.x
Subject(s) - medicine , modified rankin scale , hazard ratio , stroke (engine) , odds ratio , confidence interval , cohort study , cohort , observational study , pediatrics , ischemic stroke , ischemia , mechanical engineering , engineering
OBJECTIVES: To assess how much of the excess risk of poor outcome from stroke in people aged 80 and older aging per se explains, independent of other prognostic determinants. DESIGN: Cohort, observational. SETTING: University hospital. PARTICIPANTS: One thousand five hundred fifty‐five patients with first‐ever ischemic stroke consecutively referred to an in‐hospital Clinical Pathway program were studied. MEASUREMENTS: The relationship between age and 1‐month outcome (death, disability (modified Rankin Scale 3–5), and poor outcome (modified Rankin Scale 3–6)) was assessed, with adjustment for several prognostic factors. RESULTS: Six hundred twelve patients aged 80 and older showed worse outcome after 1 month than those who were younger, in terms of mortality (19% vs 5%, hazard ratio (HR)=3.85, 95% confidence interval (CI)=2.8–5.4) and disability (51% vs 33%, odds ratio (OR)=3.16, 95% CI=2.5–4.0), although in multivariate models, the adjusted HR for mortality decreased to 1.47 (95% CI=1.0–2.16) and the ORs for disability and poor outcome decreased to 1.76 (95% CI=1.32–2.3.) and 1.83 (95% CI=137–2.43), respectively. Stroke severity, the occurrence of at least one medical complication, and premorbid disability explained most of the risk excess in the oldest‐old. CONCLUSION: Stroke outcome is definitely worse in very old people, and most of the excess risk of death and disability is attributable to the higher occurrences of the most‐severe clinical stroke syndromes and of medical complications in the acute phase. These represent potential targets for preventive and therapeutical strategies specifically for elderly people.